Texas 2017 - 85th Regular

Texas House Bill HB4223 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	85R9141 SCL-D
2	2	By: Farrar H.B. No. 4223
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to an advance directive and do-not-resuscitate order of a
8	8	pregnant patient.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 166.033, Health and Safety Code, is
11	11	amended to read as follows:
12	12	Sec. 166.033. FORM OF WRITTEN DIRECTIVE. A written
13	13	directive may be in the following form:
14	14	DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES
15	15	Instructions for completing this document:
16	16	This is an important legal document known as an Advance
17	17	Directive. It is designed to help you communicate your wishes about
18	18	medical treatment at some time in the future when you are unable to
19	19	make your wishes known because of illness or injury. These wishes
20	20	are usually based on personal values. In particular, you may want
21	21	to consider what burdens or hardships of treatment you would be
22	22	willing to accept for a particular amount of benefit obtained if you
23	23	were seriously ill.
24	24	You are encouraged to discuss your values and wishes with
25	25	your family or chosen spokesperson, as well as your physician. Your
26	26	physician, other health care provider, or medical institution may
27	27	provide you with various resources to assist you in completing your
28	28	advance directive. Brief definitions are listed below and may aid
29	29	you in your discussions and advance planning. Initial the
30	30	treatment choices that best reflect your personal preferences.
31	31	Provide a copy of your directive to your physician, usual hospital,
32	32	and family or spokesperson. Consider a periodic review of this
33	33	document. By periodic review, you can best assure that the
34	34	directive reflects your preferences.
35	35	In addition to this advance directive, Texas law provides for
36	36	two other types of directives that can be important during a serious
37	37	illness. These are the Medical Power of Attorney and the
38	38	Out-of-Hospital Do-Not-Resuscitate Order. You may wish to discuss
39	39	these with your physician, family, hospital representative, or
40	40	other advisers. You may also wish to complete a directive related
41	41	to the donation of organs and tissues.
42	42	DIRECTIVE
43	43	I, __________, recognize that the best health care is based
44	44	upon a partnership of trust and communication with my physician. My
45	45	physician and I will make health care or treatment decisions
46	46	together as long as I am of sound mind and able to make my wishes
47	47	known. If there comes a time that I am unable to make medical
48	48	decisions about myself because of illness or injury, I direct that
49	49	the following treatment preferences be honored:
50	50	If, in the judgment of my physician, I am suffering with a
51	51	terminal condition from which I am expected to die within six
52	52	months, even with available life-sustaining treatment provided in
53	53	accordance with prevailing standards of medical care:
54	54	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR __________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
55	55	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
56	56	__________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.) __________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
57	57	__________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
58	58	If, in the judgment of my physician, I am suffering with an
59	59	irreversible condition so that I cannot care for myself or make
60	60	decisions for myself and am expected to die without life-sustaining
61	61	treatment provided in accordance with prevailing standards of care:
62	62	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR __________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
63	63	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
64	64	__________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.) __________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
65	65	__________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
66	66	In case of pregnancy:
67	67	If I am pregnant, my decision concerning life-sustaining
68	68	treatment is modified as follows:
69	69	________________________________________________________________ ________________________________________________________________
70	70	________________________________________________________________
71	71	________________________________________________________________ ________________________________________________________________
72	72	________________________________________________________________
73	73	________________________________________________________________ ________________________________________________________________
74	74	________________________________________________________________
75	75	(THIS SECTION IS OPTIONAL, IS ONLY FOR WOMEN OF CHILD-BEARING AGE,
76	76	AND DOES NOT AFFECT THE VALIDITY OF THIS FORM IF LEFT BLANK.)
77	77	Additional requests: (After discussion with your physician,
78	78	you may wish to consider listing particular treatments in this
79	79	space that you do or do not want in specific circumstances, such as
80	80	artificially administered nutrition and hydration, intravenous
81	81	antibiotics, etc. Be sure to state whether you do or do not want the
82	82	particular treatment.)
83	83	After signing this directive, if my representative or I elect
84	84	hospice care, I understand and agree that only those treatments
85	85	needed to keep me comfortable would be provided and I would not be
86	86	given available life-sustaining treatments.
87	87	If I do not have a Medical Power of Attorney, and I am unable
88	88	to make my wishes known, I designate the following person(s) to make
89	89	health care or treatment decisions with my physician compatible
90	90	with my personal values:
91	91	1. __________
92	92	2. __________
93	93	(If a Medical Power of Attorney has been executed, then an
94	94	agent already has been named and you should not list additional
95	95	names in this document.)
96	96	If the above persons are not available, or if I have not
97	97	designated a spokesperson, I understand that a spokesperson will be
98	98	chosen for me following standards specified in the laws of Texas.
99	99	If, in the judgment of my physician, my death is imminent within
100	100	minutes to hours, even with the use of all available medical
101	101	treatment provided within the prevailing standard of care, I
102	102	acknowledge that all treatments may be withheld or removed except
103	103	those needed to maintain my comfort. [I understand that under Texas
104	104	law this directive has no effect if I have been diagnosed as
105	105	pregnant.] This directive will remain in effect until I revoke it.
106	106	No other person may do so.
107	107	Signed__________ Date__________ City, County, State of
108	108	Residence __________
109	109	Two competent adult witnesses must sign below, acknowledging
110	110	the signature of the declarant. The witness designated as Witness 1
111	111	may not be a person designated to make a health care or treatment
112	112	decision for the patient and may not be related to the patient by
113	113	blood or marriage. This witness may not be entitled to any part of
114	114	the estate and may not have a claim against the estate of the
115	115	patient. This witness may not be the attending physician or an
116	116	employee of the attending physician. If this witness is an employee
117	117	of a health care facility in which the patient is being cared for,
118	118	this witness may not be involved in providing direct patient care to
119	119	the patient. This witness may not be an officer, director, partner,
120	120	or business office employee of a health care facility in which the
121	121	patient is being cared for or of any parent organization of the
122	122	health care facility.
123	123	Witness 1 __________ Witness 2 __________
124	124	Definitions:
125	125	"Artificially administered nutrition and hydration" means
126	126	the provision of nutrients or fluids by a tube inserted in a vein,
127	127	under the skin in the subcutaneous tissues, or in the
128	128	gastrointestinal tract.
129	129	"Irreversible condition" means a condition, injury, or
130	130	illness:
131	131	(1) that may be treated, but is never cured or
132	132	eliminated;
133	133	(2) that leaves a person unable to care for or make
134	134	decisions for the person's own self; and
135	135	(3) that, without life-sustaining treatment provided
136	136	in accordance with the prevailing standard of medical care, is
137	137	fatal.
138	138	Explanation: Many serious illnesses such as cancer, failure
139	139	of major organs (kidney, heart, liver, or lung), and serious brain
140	140	disease such as Alzheimer's dementia may be considered irreversible
141	141	early on. There is no cure, but the patient may be kept alive for
142	142	prolonged periods of time if the patient receives life-sustaining
143	143	treatments. Late in the course of the same illness, the disease may
144	144	be considered terminal when, even with treatment, the patient is
145	145	expected to die. You may wish to consider which burdens of
146	146	treatment you would be willing to accept in an effort to achieve a
147	147	particular outcome. This is a very personal decision that you may
148	148	wish to discuss with your physician, family, or other important
149	149	persons in your life.
150	150	"Life-sustaining treatment" means treatment that, based on
151	151	reasonable medical judgment, sustains the life of a patient and
152	152	without which the patient will die. The term includes both
153	153	life-sustaining medications and artificial life support such as
154	154	mechanical breathing machines, kidney dialysis treatment, and
155	155	artificially administered nutrition and hydration. The term does
156	156	not include the administration of pain management medication, the
157	157	performance of a medical procedure necessary to provide comfort
158	158	care, or any other medical care provided to alleviate a patient's
159	159	pain.
160	160	"Terminal condition" means an incurable condition caused by
161	161	injury, disease, or illness that according to reasonable medical
162	162	judgment will produce death within six months, even with available
163	163	life-sustaining treatment provided in accordance with the
164	164	prevailing standard of medical care.
165	165	Explanation: Many serious illnesses may be considered
166	166	irreversible early in the course of the illness, but they may not be
167	167	considered terminal until the disease is fairly advanced. In
168	168	thinking about terminal illness and its treatment, you again may
169	169	wish to consider the relative benefits and burdens of treatment and
170	170	discuss your wishes with your physician, family, or other important
171	171	persons in your life.
172	172	SECTION 2. Section 166.049, Health and Safety Code, is
173	173	amended to read as follows:
174	174	Sec. 166.049. PREGNANT PATIENTS. A woman of child-bearing
175	175	age may specify in an advance directive executed by the woman the
176	176	effect the woman's pregnancy has on the advance directive [A person
177	177	may not withdraw or withhold life-sustaining treatment under this
178	178	subchapter from a pregnant patient].
179	179	SECTION 3. Section 166.083(b), Health and Safety Code, is
180	180	amended to read as follows:
181	181	(b) The standard form of an out-of-hospital DNR order
182	182	specified by department rule must, at a minimum, contain the
183	183	following:
184	184	(1) a distinctive single-page format that readily
185	185	identifies the document as an out-of-hospital DNR order;
186	186	(2) a title that readily identifies the document as an
187	187	out-of-hospital DNR order;
188	188	(3) the printed or typed name of the person;
189	189	(4) a statement that the physician signing the
190	190	document is the attending physician of the person and that the
191	191	physician is directing health care professionals acting in
192	192	out-of-hospital settings, including a hospital emergency
193	193	department, not to initiate or continue certain life-sustaining
194	194	treatment on behalf of the person, and a listing of those procedures
195	195	not to be initiated or continued;
196	196	(5) a statement that the person understands that the
197	197	person may revoke the out-of-hospital DNR order at any time by
198	198	destroying the order and removing the DNR identification device, if
199	199	any, or by communicating to health care professionals at the scene
200	200	the person's desire to revoke the out-of-hospital DNR order;
201	201	(6) a statement that the person, if a woman of
202	202	child-bearing age, may specify in the form the effect the woman's
203	203	pregnancy has on the out-of-hospital DNR order;
204	204	(7) places for the printed names and signatures of the
205	205	witnesses or the notary public's acknowledgment and for the printed
206	206	name and signature of the attending physician of the person and the
207	207	medical license number of the attending physician;
208	208	(8) [(7)] a separate section for execution of the
209	209	document by the legal guardian of the person, the person's proxy, an
210	210	agent of the person having a medical power of attorney, or the
211	211	attending physician attesting to the issuance of an out-of-hospital
212	212	DNR order by nonwritten means of communication or acting in
213	213	accordance with a previously executed or previously issued
214	214	directive to physicians under Section 166.082(c) that includes the
215	215	following:
216	216	(A) a statement that the legal guardian, the
217	217	proxy, the agent, the person by nonwritten means of communication,
218	218	or the physician directs that each listed life-sustaining treatment
219	219	should not be initiated or continued in behalf of the person; and
220	220	(B) places for the printed names and signatures
221	221	of the witnesses and, as applicable, the legal guardian, proxy,
222	222	agent, or physician;
223	223	(9) [(8)] a separate section for execution of the
224	224	document by at least one qualified relative of the person when the
225	225	person does not have a legal guardian, proxy, or agent having a
226	226	medical power of attorney and is incompetent or otherwise mentally
227	227	or physically incapable of communication, including:
228	228	(A) a statement that the relative of the person
229	229	is qualified to make a treatment decision to withhold
230	230	cardiopulmonary resuscitation and certain other designated
231	231	life-sustaining treatment under Section 166.088 and, based on the
232	232	known desires of the person or a determination of the best interest
233	233	of the person, directs that each listed life-sustaining treatment
234	234	should not be initiated or continued in behalf of the person; and
235	235	(B) places for the printed names and signatures
236	236	of the witnesses and qualified relative of the person;
237	237	(10) [(9)] a place for entry of the date of execution
238	238	of the document;
239	239	(11) [(10)] a statement that the document is in effect
240	240	on the date of its execution and remains in effect until the death
241	241	of the person or until the document is revoked;
242	242	(12) [(11)] a statement that the document must
243	243	accompany the person during transport;
244	244	(13) [(12)] a statement regarding the proper
245	245	disposition of the document or copies of the document, as the
246	246	executive commissioner determines appropriate; and
247	247	(14) [(13)] a statement at the bottom of the document,
248	248	with places for the signature of each person executing the
249	249	document, that the document has been properly completed.
250	250	SECTION 4. Section 166.084(c), Health and Safety Code, is
251	251	amended to read as follows:
252	252	(c) The attending physician and witnesses shall sign the
253	253	out-of-hospital DNR order in the place of the document provided by
254	254	Section 166.083(b)(8) [166.083(b)(7)] and the attending physician
255	255	shall sign the document in the place required by Section
256	256	166.083(b)(14) [166.083(b)(13)]. The physician shall make the fact
257	257	of the existence of the out-of-hospital DNR order a part of the
258	258	declarant's medical record and the names of the witnesses shall be
259	259	entered in the medical record.
260	260	SECTION 5. Section 166.098, Health and Safety Code, is
261	261	amended to read as follows:
262	262	Sec. 166.098. PREGNANT PERSONS. A woman of child-bearing
263	263	age may specify in an out-of-hospital DNR order executed by the
264	264	woman the effect the woman's pregnancy has on the order [A person
265	265	may not withhold cardiopulmonary resuscitation or certain other
266	266	life-sustaining treatment designated by department rule under this
267	267	subchapter from a person known by the responding health care
268	268	professionals to be pregnant].
269	269	SECTION 6. This Act takes effect September 1, 2017.
270	270
271	271	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
272	272
273	273	__________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
274	274
275	275	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
276	276
277	277	__________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
278	278
279	279	________________________________________________________________
280	280
281	281	________________________________________________________________
282	282
283	283	________________________________________________________________